Therapy

Control the ventricular rate ^a using digoxin ^d

Alternatives include: 

• calcium-channel blockers: verapamil ^a or diltiazem ^a
• beta-blockers: esmolol ^a or sotalol ^a

Why?

• Verapamil slows the ventricular rate (on average by 40 beats/min), ^a and helps cardioversion ^a
• Diltiazem slows the ventricular rate (on average by 20 beats/min) ^a
• Esmolol ^a or sotalol ^a slow the ventricular rate, but neither has any clear effect on cardioversion

Atrial flutter: verapamil helps conversion to sinus rhythm

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
atrial flutter a	verapamil	placebo	sinus rhythm	0%	100%	3 (1 to 25)